The importance of multiple treatment modalities in a case of divergence excess

Divergence excess strabismus is a fairly common anomaly of binocular vision, characterized by constant or intermittent exotropia at distance, absence of significant amblyopia, and normal stereopsis at near. Optometric vision therapy is often effective in treating this condition. In contrast to the emphasis orthoptists (under ophthalmologic supervision) place upon pathological diplopia awareness, optometric vision therapy emphasizes development of sensory fusion and proprioceptive cues to eye alignment. A case is presented in which pathological diplopia awareness and surgery were needed to produce a functional cure after the patient failed to achieve consistent eye alignment using the regimen commonly advocated by optometrists.